# Consulting after Combat: Interviewing Service Members and Veterans to Develop a Therapy to Restore Functioning and Reintegration after Moral Injury Events

> **NIH VA IK2** · OLIN TEAGUE VETERANS CENTER · 2022 · —

## Abstract

Approximately 25% of combat Veterans with Posttraumatic Stress Disorder (PTSD) seek treatment
for traumas that involve potentially morally injurious events (PMIE) rather than danger-based traumas.
PMIEs are more strongly associated with functional and psychiatric impairment than life-threat-based
combat. Veterans report that PMIEs disrupt their sense of identity and meaning, ability to connect with
and trust others, and engender disturbing guilt, shame, rage, and disgust. The sequelae of exposure to
PMIEs, otherwise known as moral injury, may explain variance in post-deployment recovery and is a
potential unaddressed treatment target. Existing first-line treatments may be limited because they were
derived from civilian contexts, poorly fit the war zone context, and do not allow Veterans to discuss the
details of the PMIEs with other Veterans. This project will develop a relational dynamic-based group
therapy treatment manual that will target functioning and quality of life among Veterans who are
impacted by high magnitude PMIEs. The goal of this relational dynamic trauma therapy is to help
Veterans identify connections between their current symptoms and their experiences in combat/PMIEs,
their current life stressors and relationships, and the historical factors that carry person-specific meaning
to their trauma/PMIE. These explorations take place in the presence of attuned and sympathetic others
who can resonate to the experience and the affect being expressed. Symptom reduction occurs through
increasing the Veteran’s capacity to consciously reflect on their experiences and develop an integrated
self-awareness of the various factors that affect their mental states. The result is greater self-reflection,
less avoidance, and greater adaptive incorporation of life experiences and their aftermath and meanings
into one’s inner world. This CDA-2 will employ innovative user-centered design methods that
continuously gather user experiences during treatment development, with the goal of increased
effectiveness and usability. User feedback will be synthesized with formative feedback from a clinical
expert panel. This objective will be accomplished by pursuing these specific aims: Aim 1: Discover
user needs and preferences as well as treatment-engagement barriers and facilitators from the
perspectives of PMIE-impacted Veterans and [VA trauma clinicians]. Aim 2: Design a treatment manual
and refine it using feedback from Veterans, [trauma clinicians], and an expert clinical advisory board.
Aim 3: Conduct two rapid prototyping open trials (i.e., tangibly testing treatment approaches using a
prototype manual) with PMIE-impacted Veterans (N = ~12), and iteratively revise the manual based on
Veteran, provider, and clinical expert panel feedback, with the following hypothesis: The treatment
manual will meet usability, feasibility, learnability, and acceptability criteria.

## Key facts

- **NIH application ID:** 10315112
- **Project number:** 1IK2RX003495-01A2
- **Recipient organization:** OLIN TEAGUE VETERANS CENTER
- **Principal Investigator:** Sheila Frankfurt O'Brien
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2022
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-11-01 → 2027-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10315112

## Citation

> US National Institutes of Health, RePORTER application 10315112, Consulting after Combat: Interviewing Service Members and Veterans to Develop a Therapy to Restore Functioning and Reintegration after Moral Injury Events (1IK2RX003495-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10315112. Licensed CC0.

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